Abinash Panda

Abstract

Introduction: Childhood asthma represents a significant burden, not only in terms of morbidity and reduced quality of life but also in terms of healthcare costs, as reflected by the high rates of unscheduled emergency department visits, hospitalization, and school absenteeism. Parents play a key link in asthma management and adherence to treatment regimen in the early years of childhood before children can manage their asthma independently. However, some parents have misconceptions regarding asthma and its medication, which could in turn influence children’s control of asthma. Objective: To find out the effect of parental beliefs and practices with respect to their knowledge about etiology, folk beliefs, home remedies, alternative therapies, etiology and pharmacotherapy in childhood asthma influence the pharmacotherapy and outcome of asthma management. Materials and Methods: The hospital based cross sectional study was carried out on a convenience sample of 82 parents of children, 5-14 years of age and clinically diagnosed with asthma of any form in the Department of Pediatrics, F.M. Medical College & Hospital, a tertiary care teaching hospital in Balasore town in the eastern part of India. The parents’ beliefs and practices were captured with the help of a pre-designed and validated questionnaire. Descriptive analytical statictics was used to analyse the demographic data. Chi square test was used to find out the association of beliefs, use of home remedies, folk beliefs and alternative therapies and the use of prescribed asthma medications as per standard reference. GraphPad Prism free trial version 7.0 was used for statistical analysis. Statistical significance was taken at a level of p ? 0.05. Results: Majority of the children were in the age group of 10-14 years with a male predominance. Most of the primary care givers less than 40 years age and literate, 30 (36.6%) having more than two children and a family history of asthma. The common beliefs were that asthma was chest allergy, of hereditary origin. Exposure to dust, indoor smoke believed to be a significant potential triggering factor for asthma attack The participants (68.2%) believed that inhaled steroids had more side effects lead to dependency also believed using inhaler only when serious. Domiciliary treatment was preferred. ????-agonist were the commonest medications. Conclusion: Parental beliefs and practices have a predominant role in the management of asthma in children. In order to enhance the level of perceptions among caregivers, education should include knowledge about asthma and its management, as there might be misperceptions about the use of inhalers and the safety of inhaled corticosteroids.   Keywords: Childhood asthma, Parental beliefs, Practices

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Background: Heart failure with preserved ejection fraction (HFpEF) is now considered as distinct syndrome. Epidemiological studies have observed its prevalence to be about 50% among the heart failure patients. Heart failure with reduced ejection fraction (HFrEF) there is an eccentric ventricular remodeling whereas, in HFpEF there is concentric remodeling. The steeper end-systolic pressure– volume relationship is steeper leading to a marked sensitivity to volume changes. There is also a substantial drop in blood pressure with vasodilator therapy. Right ventricular (RV) structure and function show chronic changes. The present study was carried out to find out the changes in RV structure and function over time in patients with HFpEF using established echocardiographic parameters. Materials and Methods: The longitudinal study was carried out on a convenience sample of 100 patients with heart failure and having preserved ejection fraction. Patients were managed as per the standard guidelines of ESC heart failure management. The outcome variables like systolic blood pressure, diastolic blood pressure, heart rate, NYHA functional capacity class, number of re-hospitalizations for heart failure during the study period and cardio-vascular mortality were measured at baseline and at 12 months. Apart from routine investigations, transthoracic echocardiography was performed. Descriptive statistics was used to present the data. Data analyis was done using GraphPad Prism 7.0 (trial version). Results: Majority of patients of HFpEF were between 71-80 years of age. Systemic hypertension was the commonest co-morbidity. 58% patients were in NYHA functional class I and 28% patients had NYHA class IV. 23% patients had RV dysfunction at baseline based on the fractional area change criteria with FAC < 35> Conclusion: Right ventricular dysfunction marked by a significant structural and functional deterioration is an important pathophysiological aspect in patients with HFpEF.   Keywords: Heart failure with preserved ejection fraction (HFpEF), right ventricular structure and function, transthoracic echocardiograph

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Background: Pulmonary tuberculosis (PTB) is one of the most common infectious diseases & Continues to be the major health problem even today. Sputum smear negative (SSN) pulmonary tuberculosis is about 40% to 60% of the clinical and radiological suspected cases of pulmonary TB. Establishing early diagnosis and starting treatment early can have significant effect on morbidity and mortality in these patients. Broncho alveolar lavage (BAL) was obtained by fibro optic bronchoscopy (FOB) Objectives: Minimising the under and over use of anti-tubercular therapy in diagnosis of pulmonary TB. To compare between the sputum CBNAAT with BAL fluid CBNAAT , compare between sputum CBNAAT with BAL fluid AFB staining, compare between BAL fluid CBNAAT with BAL fluid AFB in diagnosis of SSN PTB. Materials and Methods: 108 SSN patients with clinical and radiological findings of PTB were taken. BY FOB BAL obtained and subjected to CBNAAT. Sputum samples of the above patients were subjected to CBNAAT and compared. Results: In this study commonest age group was 18 to 39 years;64 patients (59.25%). Males (57.40%) were more in numbers than females (42.59%). In our study, 24(25.92%) were alcoholic and 84 (90.72%) were non alcoholic. 68(73.44%) had co-morbid conditions. Out of them 28 (30.24%) were of obstructive airways disease which was the commonest co-morbidity. BAL CBNAAT Mtb detection was better than BAL AFB smear, sputum CBNAAT was significantly better than BAL AFB smear & BAL CBNAAT was better than sputum CBNAAT. Conclusion: BAL CBNAAT is useful in the early diagnosis of sputum smear negative pulmonary tuberculosis cases   Keywords: Sputum, Broncho alveolar lavage, CBNAAT, Sputum smear negative, Fibro optic bronchoscopy

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Introduction: Age is a strong and independent risk factor for the development of coronary atherosclerosis. AMI is a disease of older population and is uncommon in young, though it occurs at younger age in India compared to Western population. This emphasizes the growing importance of examining the risk factors and outcomes in the elderly and young in discrete populations. With age, multiple co-morbidities develop that intertwine and fundamentally alter the management of CVD. The primary objective of the present study is to compare the risk factors, clinical features, outcomes of AMI in elderly (age 3 60 years) and younger patients with AMI (age < 60> Materials and Methods: This hospital based observational study was carried out on 200 study participants of either gender, with a diagnosis of AMI recruited on the basis of simple random sampling with replacement using a random number table. For the purpose of comparison 100 cases of AMI below the age of < 60> Results: Mean age of patients in the Group I (young, age more frequently seen in elderly. LMCA was more involved in elderly patient. Thrombolysis was done in less in elderly compared to young, so also -blockers, ACEI were used less in the elderly. The elderly had a higher mortality on 1st; 7th and 30th day of follow-up. Conclusion: Manifestations of AMI in elderly are more subtle with more atypical presentations and have higher rate of complications and mortality. A high index of suspicion is important in elderly patients to achieve a timely management. Keywords: Acute Myocardial Infarction, Risk factors, Outcome, Age.

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